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NPTE Final Frontier > MEGA REVIEW DAY 1 > Flashcards

MEGA REVIEW DAY 1 Flashcards

1
Q

Normal end feels: 3

A

Hard: bone to bone stiff sensation that is painless Ex. Elbow EXT
Soft: yielding compression Ex. Elbow/knee flex
Firm: toward end ROM= elastic resistance Ex. ER shoulder (lig or capsular end feel restricting more mvmt)

PAIN and end feel? == Empty bc wont get full ROM from them!

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2
Q

EmPty end feel think…

A

Pain

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3
Q

Abnormal End Feels:

A

Springy–> meniscus tear
Boggy–> edema
Mushy–>
Empty–> Pain

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4
Q

Scapular Winging types: 2
most common?

A
  1. Open book palsy/Medial winging–> Serratus Ant (Long thoracic N.)
  2. Sliding door palsy/Lateral winging–> Trapz (CN XI)

activate SA–> push up, SA pushup

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5
Q

Scapular UPWARD rot and DOWNWARD rot

A

UPward: Upper/Lower trpz, Serratus Ant
DOWNward: Pec minor, rhomboids, levator scap

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6
Q

When will you SEE medial winging d/t Serratus ant (long thoracic nerve) lesion?

A

Lifting arm above 90degs shoulder FLEX
THINK… bc Serratus punches are given @ 90degs shoulder flex

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7
Q

Heart sounds

A

APT-M 2245
Mitral site BEST for auscultation if S3 (vent gallop) present

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8
Q

Heart sounds

A

APT-M 2245
Mitral site BEST for auscultation if S3 (vent gallop) present

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9
Q

Erbs point auscultation

A

5th point–> 3rd ICS

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10
Q

More on heart sounds:

A

S1/2== normal
S3 (CHF)/4(HTN, MI, vent hypertrophy)== abnormal (will hear these @ apex, mitral valve)

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11
Q

RPE (6-20 scale) and SHVEM

A

Start @ 13!
S= 13 (Somewhat hard)
H= 15 (Hard)
V= 17 (Very hard)
E= 19 (Extremely hard)
M= 20 (Max exertion)
REVERSE SHVEM, start @ 13
S= 13 (Somewhat hard)
H= 11 (Light just opp hard)
V= 9 (Very light)
E= 7.5 (Extremely light)
M= 6 (No exertion)

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11
Q

RPE (6-20 scale) and SHVEM

A

Start @ 13!
S= 13 (Somewhat hard)
H= 15 (Hard)
V= 17 (Very hard)
E= 19 (Extremely hard)
M= 20 (Max exertion)
REVERSE SHVEM, start @ 13
S= 13 (Somewhat hard)
H= 11 (Light just opp hard)
V= 9 (Very light)
E= 7.5 (Extremely light)
M= 6 (No exertion)

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12
Q

RPE rx for DM

A

11-13 for DM, progress to 12-17

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13
Q

EASY way to breakdown Dermatomes

A

C1-C4= head/neck
C5-T1= arm
C6-C8= fingers

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14
Q

Sensory Examination

Superficial Sensation

A

Exteroreceptors–> Receive stimuli from EXTERNAL environment via skin and subQ tissue Ex. Pain, temp, lt touch

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15
Q

Sensory Examination

Deep Sensation

A

Proprioreceptors–> Receive stim from mm’s, tendons, fascia
Ex. Pos. sense/awareness of jts @ rest, kinesthesia, vibration

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16
Q

Sensory Examination

Cortical Sensation

A

Combo of BOTH Superf/Deep
Ex. Stereognosis (ID obj), 2-pt discrim, barognosis (pressure), graphestesia (drawing letters), localization, recognition of texture, double simultaneous stimulation

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17
Q

DCML mnemonic

A

Poor Val Got GBS Twice
Proprio, Vibration, Graphestesia, Barognosis, Stereognosis, 2-pt discrim

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18
Q

Lateral Spinothalamic (STT)
Ant STT

A

Lateral= Pain + Temp
LPT
Anterior= crude touch

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19
Q

Glasgow Coma Scale
All w/ mnemonics

A

See pic

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20
Q

Glasgow Coma Scale Totals

A

<8= coma
3-8= severely abnormal
9-12= moderately abnormal
13-14= mildly abnormal
15= mild TBI

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21
Q

Glasgow Coma Scale
EMV
4, 6, 5

A
  • Eyes (4 letters, so 4)
  • Verbal (the V in front is 5 roman numeral)
  • Motor (remaining 6)
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22
Q

Glasgow Coma Scale
HOW to remember Ea section

A

Eyes Opening (1-4)– “Waking husband up Sunday morning”
- 4: Spontaneous (he spontaneously wakes up on his own)
- 3: To speech (you call him to wake up)
- 2: To pain (you pinch him to wake up)
- 1: No response

Motor (1-6)– “OLD BEN”
- 6: Follows motor commands (Obeys commands)
- 5: Localizes
- 4: w/Drawals (flexor w/drawal)
- 3: Abnormal flexion (Bending)
- 2: Extensor resp
- 1: No resp

Verbal (1-5)– Think baby or child growing up (meaning lvs going UP)
- 1: No response
- 2: Incomprehensible sounds (making sounds)
- 3: Inappropriate words (saying words)
- 4: Confused conversation (having conversation)
- 5: Oriented

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23
Q

Normal Blood Gases

A

PaCo2: 35-45
pH: 7.35-7.45
HCO3-: 22-26
Remember ROME
Resp (CO2)–> OPP to pH direction; Metabolic (HCO3-)–> EQUAL to pH direction

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24
Q

pH + Normal Blood Gases Questions
STEPS!

A
  1. Look @ pH
    Normal 7.35-7.45: Answer is Compensated
  2. Look @ PaCO2
    Normal 35-45: Answer is Metabolic
  3. Look @ HCO3-
    Normal 22-26: Answer is Respiratory
  4. None of three are normal
    Answer is Partially Compensated
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25
Q

Stages of Lymph03dema
(0-3)
ALL FIRST

A

see pics

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26
Q

Stage 0 Lymph03dema

A

Latency
- NO edema (Heaviness only)
- NEGATIVE stemmer
- Tissue/skin appear normal

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27
Q

Stage 1 Lymph03dema

A

Reversible
- Edema present (PITTING)
- Edema INCs w/ standing/activity
- NEGATIVE stemmer

28
Q

Stage 2 Lymph03dema

A

Spontaneously IRreversible
- Edema present; soft/pitting EARLY then progresses to brawny, NONpitting
- POSITIVE stemmer (maybe neg. early on)
- Tissue appears fibrosclerotic; proliferation of adipose tissue

29
Q

Stage 3 Lymph03dema

A

Lymphostatic Elephantiasis (think elephant feet)
- Edema present; SEVERE brawny, NONpitting
- POSITIVE stemmer
- SKIN CHANGES!!!!–> Papillomas, deep skinfold, warty protrusions, hyperkeratosis, mycotic infxs

30
Q

Stages of LIPedema

A

2 lips== B/L, P is for proximal, LEs only, NEVER feet
See pics

31
Q

Lymph03dema vs LIPedema

A

NOTE w/ Lymphedema:
- U/L OR B/L asymmetric
- cellulitis common
- NO pain
- distal edema present in foot
- Stemmer (+), Stages II/III

32
Q

Cranial Nerves
How do you remember where they ARE?

A

CE (1,2), MI (3,4), PONS (5,6,7,8), MEDU (9, 10, 11, 12)

33
Q

CN 7 and 9 differentiation

A

7 (facial)= ANT
9 (trigeminal)= POST (P is backwards 9)
Taste= facial
Sensory= Trigeminal

34
Q

Common gait abnorms: 4
ELABORATE

A
  1. Step LENGTH deviations (FLOP= tight hip flexors OPP leg step leg length
  2. Trunk bending deviations (Magnet Theory in STANCE only!!!)
  3. LLD deviations (think David in his High Heels)
  4. Inad mm control deviations
35
Q

IMPORTANT Gait definitions

A

Gait cycle: Heel strike to next I/L heel strike
Stride: one full gait cycle (heel strike to NEXT same foot heel strike)
Step: One foot to the other foot

36
Q

Ex. shorter step length on R. side

A

A: R. glute max contracture
- Tight EXTs or stuck in EXT, SO will have shorter step length bc cant go into hip flexion bc EXTs are tight!!!

37
Q

2 Tests for High Ankle Sprain
Think TIBIOfibular ligament!!!

A
  1. Syndesmotic squeeze (Hopkin’s) Test– bc gapping @ the syndesmosis distally
  2. Kleigers (ER/DF) Test –crank on it– NEUTRAL foot and have them short sit w/ foot hanging off edge–Same MOI as high ankle sprain
38
Q

Ankle special tests differentiation:

A

Talar tilt w/ ankle in neutral DF== CFL, can also tilt into EVERSION for deltoid lig (medial ligs)
Ant Drawer w/ ankle neutral DF== Anterior TALOfibular lig (depending on where you stabilize/mob== ligs tested (ATFL vs deltoid ligs)
Compression of shafts of tib/fib @ mid calf== Syndesmotic squeeze== TIBIOfibular ligament
Squeezing calf w/ ankle neutral DF== Thompson== Achilles rupture— + will be absent PF

39
Q

Appendicitis tests
RLQ pain==AC==Appendicitis/Crohn’s

A
  1. Obturator sign (ER)– passive stretch into IR, supine
  2. Psoas sign (hip flexor)– passive stretch into hip EXT, S/L w/ affected side UP
  3. McBurneys pt– bw ASIS/umbillicus–RLQ
  4. Rovsing’s Sign– palpate LLQ== pain in RLQ

MORE!–> Blumbergs (rebound tender), Inch+Pinch on R (right on appendix site), Single hop test (RLQ pain), Markel sign (heel drop sign)

40
Q

3 Diff Murphy’s Signs

A
  1. Acute Cholecystitis–gallbladder- RUQ– deep breath and pull up into rib one
  2. Murphy’s Punch for Kidneys–kidneys- pyelonephritis
  3. Lunate dislocation (hand)– knuckles lining up one (middle knuckle lines up= (+)– remember middle knuckle usually protrudes out more
41
Q

Referred Pain Patterns
ALL!!!!

A

RUQ: Good Luck Hot Pack (Gallbladder, Liver, Head of pancreas, Peptic ulcers
RLQ: AC (Appendix, Crohn’s)
LUQ: Dont Banana Split (Diaphragm, Body/tail of pancreas, SpLeen (Kehrs sign) SLR and pain in L. shoulder)
LLQ: DUI (Diverticulitis, Ulcerative colitis, IBS)

Heart== L shoulder/arm

42
Q

Functional Independence Measure (FIM)
Assist lvls–Patient participitation
7 (BEST)–> 1 (WORST)

A

Outcome measure assesses lvl of functional status of person based on lvl of assistance required
7: COMPLETE IND (timely, safely)
6: MOD IND (use of AD)
5: Supervision (cueing, setup, coaxing)
4: MIN A (Pt participation= 75% or more)
3: MOD A (Pt participation= 50-74%)
2: MAX A (Pt participation= 25-49%)
1: DEPENDENT (Pt participation= LESS than 25%)

43
Q

Straight Leg Raise Test: 4
SLR (Basic), SLR 2, SLR 3, SLR 4

A

SLR (Basic)–Sciatic + Tibial
- Hip flex/add
- Knee ext
- Ankle DF
SLR 2 (TED-Tibial Eversion DF)–Tibial
- Hip flex
- Knee ext
- Ankle DF
- Foot eversion
- Toe ext

SLR 3 (SID- Sural Inversion DF)–Sural
- Hip flex
- Knee ext
- Ankle DF
- Foot inversion

SLR 4 (PIP–Peroneal Inversion PF)–Common Peroneal
- Hip flex + IR
- Knee ext
- Ankle PF
- Foot inversion

44
Q

LBP Conditions Table

A

See Table:
Breakdown:
1. Spondys vs
2. Disc Herniation vs
3. Spinal stenosis (narrowing of vert canal)

45
Q

LBP Cond’s

Spondy’s

A

Spondylosis–think DEGEN, >50yo
Spondylolysis–think Pars fx, scotty dog, 15-20yo
Spondylolisthesis–think slippage (usually anterior), 20yo (can progress to degen w/ age)– TEST= Stork Test
Aggravating factors: Ext, Standing mostly; bending to lift objs (spondylolysis/listhesis)
Relieving factors: Sitting (all 3); bending (spondylosis)
SLR Test: NEGATIVE all 3
Imaging: X-ray (all 3)

46
Q

LBP Cond’s

Disc Herniation (think posterolat nucleus protrusion)

A

Age: 30-50
Loc: Back, leg (U/L)
Aggravating: Sitting (flex bias), Bending, Ascending stairs
Relieving: Extension, Standing (Ext bias), Descending stairs
SLR Test: POSITIVE
Imaging: MRI/CT–bulging disc

47
Q

LBP Cond’s

Spinal Stenosis
Test: Van Gelderan
Think narrowing vert canal
“The shopping cart leaners”

A

Age: >60
Loc: back, legs (B/L)
Aggravating: Ext, Standing (Ext bias)
Relieving: Sitting, Bending
SLR: POSITIVE
Imaging: CT, MRI and X-ray

48
Q

HypERthyroid- “Hyper David who never gains wt”
HypOthyroid- “Lazy husband laying on couch all day w/ comforter”
ALL FIRST

A

See table:
HypER– sped up
HypO– slowed down

49
Q

HypERthyroid
Dis’s== Exopthalmos (bulging eyes), Grave’s

A
  • INCd T3/4== LOW TSH (bc trying to lower T3/4)
  • INCd HR, DEC BP (bc NOT sedentary)
  • High BMR (sped up)
  • Heat INtolerance (bc always moving/sweating)
  • INCd GLU absorb (bc moving always)== Lower blood glucose
  • Restless, insomnia (obv)
  • Diarrhea (bc sped up)
  • Silky hair, moist palm (bc always sweating)
  • Wt LOSS + Incd appetite (always eating, never gain wt)
  • INCd perspiration
  • HYPERreflex (bc HYPERthryoid)
50
Q

HypOthyroid
Dis’s== Myxedema, Hashimoto’s

A
  • DECd T3/4, HIGH TSH bc trying to INC T3/4
  • DECd HR, HIGH BP (bc sedentary so makes sense)
  • Low BMR (slowed down)
  • COLD intolerance (lazy guy laying on couch w/ comforter, hes cold)
  • DECd GLU absorb (sedentary), higher blood glucose
  • Sleepy, tired, Prox mm weakness (bc laying on shoulder & prox mm’s)
  • Constipation (bc slowed down)
  • Brittle nails, dry skin and hair (bc slowed down)
  • Wt GAIN, decd appetite (not eating, but still gain wt)
  • Decd perspiration (not moving)
  • Prolooonged DTRs (bc HypOthyroid)
51
Q

Types of HAs
ALL FIRST

A

U/L= Cervicogenic, Cluster, Migraines
B/L= Tension

52
Q

Types of HA:

Cervicogenic

A

U/L
- pain in occipital region– spreads to frontal area
- Sx’s aggravated by mvmt or sustained postures

53
Q

Types of HA:

Cluster
the “stabbing pain” one

A

U/L, M>F
- pain around one eye
- sharp, stabbing, throbbing
- Autonomic sx’s: sweating face, lacrimation

54
Q

Types of HA:

Migraines
“photophobia” one

A

U/L, F>M
- pain on one side of face
- pulsating quality
- Aggravation w/ routine phys act and assocd w/ nausea, vom, photophobi

55
Q

Types of HA:

Tension
ONLY B/L one

A

B/L, band across forehead one
- Tight or pressure across forehead like a band
- Mm tightness/tender in facial and CS mm’s
- Assocd w/ stress, anxiety, depress– aka STUFF THAT CAUSES TENSION!!!

56
Q

Aquatic Therapy
All first
Think Heart is HAPPY

A

see table

57
Q

Active Insuff vs Passive Insuff

A

Active= SAME motion as mm
Passive= OPPOSITE motion as mm

58
Q

One (psoas) and Two (Rec Fem) Joint Hip Flexor

A

Psoas– 1 jt hip flexor–crosses 1 jt
Rec Fem– 2 jt hip flexor– crosses 2 jts: Hip AND Knee
Thomas Test Interpretations: Sign vs Structures Affected
- EXTd knee==> Quads, rec fem
- Flexed hip==> Psoas
- Abd’d hip==> TFL/ITB
- Lateral rotation of tibia==> Biceps fem (bc biceps fem, lateral HS== ER tibia + knee flex)

If you see Thomas Test question + hip FLEXOR stretch– go w/ Thomas Test – think HIP FLEXORS
Ely’s Test— think QUADS!!!!

59
Q

AV Blocks Summary

A

Block, ECG Interp, PT Response:
- First Degree– INC PR interval (looong PR)– Continue exercise, benign
- Second Degree Type I (Weckenbach)– Progressive inc in PR interval, then DROP! (long, looonger, drop)– Monitor and cont @ LOWER intensity
- Second Degree Type II (Mobitz II)– Normal PR interval until SUDDEN drop (norm, norm, drop)– STOP exercise, NO 911
- Third Degree–No relationship (NO comm. bw Ps & Qs)–Stop IMMEDIATELY and refer, 911!!!

60
Q

PICO question
What is it? Example?

A

P: Population/Problem (Ex. LBP)
I: Intervention/Dx/Prognosis (Ex. traction)
C: Comparison bw Tx groups (Ex. nothing)
O: Outcome measures used to measure variables (Ex. Outcome, Dep variable)

61
Q

How do you remember Independent variable?

A

I for I
Ind variable is the Intervention!!!

62
Q

Isolated Precautions
ALL FIRST

A

See table

63
Q

Isolated Precautions: KEY STUFF

Iso Type: Contact Precautions

A

MRSA, VISA, VRE, C-Diff, Hep-A/B
PPE: Gloves & Gown
Hand wash BEFORE and AFTER

64
Q

Isolated Precautions: KEY STUFF

Droplet Precautions

A

Mumps (Rubella), Strep, Meningitis, PNA, Influenza
PPE: Mask when w/in 3ft
Hand was UPON ENTERING and Leaving room

65
Q

Isolated Precautions: KEY STUFF

Airborne Precautions

A

Measles, TB, Varicella, Herpes Zoster (dermatomal pattern rash)
PPE: N-95 mask, Gown and Gloves–discard mask upon LEAVING room
Hand was UPON ENTER and LEAVING
private room w/ NEGATIVE air flow

66
Q

Heart sounds and CLOSING of valves

A

S1– assocd w/ closing of Tricuspid/Mitral valves– “S1TM”
S2– assocd w/ closing of Aortic/Pulmonic valves– “S2AP”, SAP and 2 looks like S
S3– early DIASTOLE– CHF– heard @ apex (bottom of heart–mitral valve
S4– MI/HTN/Vent hypertrophy– heard @ apex (bottom of heart–mitral valve

67
Q

WOUNDS!

A

Arterial– LAT malleolus– pain w/ elevation
Venous (VenMO)– MEDIAL malleoulus– elevation DECs pain (gravity assists w/ venous return)

68
Q

MS and Unthoff’s

A

Neuro sx’s worsen w/ in the heat
AVOID HEAT
“Oof, its hot”

NPTE Final Frontier (19 decks)

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